51
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Pinto Pereira J, Lelotte J, Ghaye B, Laterre PF, Hantson P. Pulmonary tumor thrombotic microangiopathy in a patient with a metastatic urothelial carcinoma. Urol Case Rep 2021; 38:101668. [PMID: 33889498 PMCID: PMC8050002 DOI: 10.1016/j.eucr.2021.101668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/28/2022] Open
Abstract
A 78-year-old woman was admitted for acute dyspnoea. One year before, she had been treated with cisplatin and gemcitabine for a high grade urothelial carcinoma. Immunotherapy was discussed 9 months later due the progression of bone metastases but could not be administered before this episode of respiratory distress. There was a major discrepancy between the findings of a limited pulmonary embolism at thoracic tomodensitometry and the severity of a recently developed pulmonary hypertension at echocardiography. The patient presented cardiac arrest on day 6 and post-mortem findings were consistent with diffuse pulmonary tumor thrombotic microangiopathy, a rare complication of urothelial carcinoma.
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Affiliation(s)
- Joao Pinto Pereira
- Department of Intensive Care, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Julie Lelotte
- Department of Pathology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Benoit Ghaye
- Department of Radiology, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Pierre-François Laterre
- Department of Intensive Care, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques Universitaires St-Luc, Université Catholique de Louvain, Brussels, Belgium
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52
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Fujisawa F, Kunimasa K, Kano-Fujiwara R, Sato Y, Kusama H, Nishio M, Matsui S, Yoshinami T, Kittaka N, Nakamura H, Nagata S, Honma K, Yagi T, Nakayama T, Tamaki Y, Imamura F. STK11 loss drives rapid progression in a breast cancer patient resulting in pulmonary tumor thrombotic microangiopathy. Breast Cancer 2021; 28:765-771. [PMID: 33389615 DOI: 10.1007/s12282-020-01200-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/27/2020] [Indexed: 11/28/2022]
Abstract
We experienced a case of breast cancer in which liver metastases spread rapidly and the patient died of pulmonary tumor thrombotic microangiopathy (PTTM). PTTM is a fatal cancer-associated respiratory complication disease. To reveal genetic alterations of the clinical course, we performed next generation sequencing of the serial specimens using the Ion AmpliSeqTM Comprehensive Cancer Panel and RNA sequencing for transcriptomic data, followed by gene set analysis. The analysis revealed an oncogenic TP53 R213* mutation in all specimens and STK11 loss in tissues sampled after disease progression. Immunohistochemistry with an anti-STK11 antibody confirmed no STK11 expression in the samples after progression. Transcriptome analysis showed a significant downregulation of proteins associated with apoptosis in the specimens with STK11 loss. STK11 loss may have triggered the rapid progression of PTTM from a comprehensive genomic analysis.
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Affiliation(s)
- Fumie Fujisawa
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Kei Kunimasa
- Department of Thoracic Oncology, Osaka International Cancer Institute, 3-1-69 Otemae Chuoku, Osaka, 541-8567, Japan.
| | - Rieko Kano-Fujiwara
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | | | - Hiroki Kusama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Minako Nishio
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Saki Matsui
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tetsuhiro Yoshinami
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Nobuyoshi Kittaka
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Harumi Nakamura
- Laboratory of Genomic Pathology, Osaka International Cancer Institute, Osaka, Japan
| | - Shigenori Nagata
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Keiichiro Honma
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka, Japan
| | - Toshinari Yagi
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takahiro Nakayama
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yasuhiro Tamaki
- Department of Breast and Endocrine Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Fumio Imamura
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
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53
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Vaideeswar P, Aswani Y, Damani S, Singaravel S. Pulmonary microvascular metastases in cervical carcinoma: A case series. J Postgrad Med 2020; 66:155-158. [PMID: 32675452 PMCID: PMC7542055 DOI: 10.4103/jpgm.jpgm_243_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Pulmonary microvascular tumor embolism (PMTE), pulmonary tumor thrombotic microangiopathy (PTTM), and lymphangitis carcinomatosis (LC) have an intricate pathophysiology and usually occur with cancers of breast, stomach, and lung. Microvascular pulmonary metastases attributable to cervical cancer are a rarity. Clinical presentation and autopsy findings of patients with microvascular pulmonary metastases in cervical cancers were studied with a review of literature. Four patients (mean age of 55.5 years) with carcinoma cervix showed microvascular metastases. Three of whom presented with respiratory symptoms, and the fourth case was unresponsive on presentation. Each patient succumbed to their illness shortly after admission. Autopsy examination performed on each patient depicted varying combination of PMTE, PTTM, and LC, all with squamous histology. This case series highlights the rare association of carcinoma cervix with the aforementioned microvascular phenomena. Besides, it underscores the sequential mechanism of occurrence of microvascular pulmonary metastasis and the associated guarded prognosis.
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Affiliation(s)
- P Vaideeswar
- Department of Pathology, Seth GS Medical College, Mumbai, Maharashtra, India
| | - Y Aswani
- Department of Radiology, Seth GS Medical College, Mumbai, Maharashtra, India
| | - S Damani
- Department of Pathology, Seth GS Medical College, Mumbai, Maharashtra, India
| | - S Singaravel
- Department of Pathology, Seth GS Medical College, Mumbai, Maharashtra, India
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54
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Shah AT, Bernardo RJ, Berry GJ, Kudelko K, Wakelee HA. Two Cases of Pulmonary Tumor Thrombotic Microangiopathy Associated with ROS1-Rearranged Non-Small-Cell Lung Cancer. Clin Lung Cancer 2020; 22:e153-e156. [PMID: 33153897 DOI: 10.1016/j.cllc.2020.09.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 09/13/2020] [Accepted: 09/14/2020] [Indexed: 02/02/2023]
Affiliation(s)
- Arpeet T Shah
- Division of Oncology, Stanford University, Stanford, CA
| | - Roberto J Bernardo
- Division of Pulmonary, Allergy and Critical Care, Stanford University, Stanford, CA
| | - Gerald J Berry
- Department of Pathology, Stanford University, Stanford, CA
| | - Kristina Kudelko
- Division of Pulmonary, Allergy and Critical Care, Stanford University, Stanford, CA
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55
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Shiono A, Fujino T, Kaira K, Kato T, Yasuda M, Kobayashi K, Kagamu H. Primary thymic adenocarcinoma with an aggressive clinical course: An autopsy case showing signet ring cell-like features. Thorac Cancer 2020; 11:3609-3613. [PMID: 33044008 PMCID: PMC7705633 DOI: 10.1111/1759-7714.13700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 09/26/2020] [Accepted: 09/26/2020] [Indexed: 01/22/2023] Open
Abstract
Thymic adenocarcinoma is an extremely rare neoplasm, and little is known about its pathogenesis and clinical characteristics. A 52‐year‐old man presented to our clinic with severe dyspnea. At initial presentation, massive carcinomatous pleuritis and pericarditis were observed, and a lobulated mass in the anterior mediastinum was found on computed tomography. Cytological examination revealed adenocarcinoma accompanied by signet ring cells; however, his tumor showed aggressive growth without any possibility of treatment, and he died as a result of cancer progression within one month of admission. An autopsy confirmed thymic adenocarcinoma showing various histological features including mucinous, signet ring cell‐like, and trabecular features. Immunohistochemically, the tumor cells were positive for cytokeratin (CK) (AE1/AE3) but negative for TTF‐1. In addition, some tumor cells were positive for CD5 and KIT. Further examination revealed that tumor cells of the nonmucinous type were positive for CK7, and negative for CK20 and caudal‐type homeobox 2 (CDX2). The tumor cells with mucinous and signet ring‐like features were positive for CK20 and CDX2 and negative for CK7, indicating enteric differentiation. In particular, tumor cells with signet ring cell‐like features indicated widespread lymphangitic carcinomatosis and pulmonary tumor thrombotic microangiopathy (PTTM). The presence of signet ring cell‐like features with enteric differentiation is suggestive of a fulminant clinical course due to widespread lymphangiosis carcinomatosa and PTTM in patients with thymic adenocarcinoma. Key points Thymic adenocarcinoma is an extremely rare neoplasm. Histological features of thymic adenocarcinoma include mucinous, signet ring cell‐like, and trabecular features. Tumor cells with signet ring cell‐like features indicate widespread lymphangitic carcinomatosis and pulmonary tumor thrombotic microangiopathy. The presence of signet ring cell‐like features with enteric differentiation is associated with a fulminant clinical course.
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Affiliation(s)
- Ayako Shiono
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Takashi Fujino
- Department of Pathology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Tomomi Kato
- Department of Pathology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Masanori Yasuda
- Department of Pathology, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama Medical University, Saitama, Japan
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56
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Parama JK, Hashimoto N, Murota M, Jinno K, Tsunemori H, Nakano-Narusawa Y, Yamakawa K, Saoo K, Yokohira M, Imaida K, Kuroda N, Matsuda Y. Pulmonary tumor thrombotic microangiopathy caused by urothelial carcinoma: An autopsy-proven case of a rare etiology. Pathol Int 2020; 70:1037-1039. [PMID: 33038266 DOI: 10.1111/pin.13032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- John K Parama
- Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Nozomi Hashimoto
- Oncology Pathology, Department of Pathology and Host Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Makiko Murota
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Keisuke Jinno
- Emergency Medical Center, Kagawa University Hospital, Kagawa, Japan
| | - Hiroyuki Tsunemori
- Department of Urology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yuko Nakano-Narusawa
- Oncology Pathology, Department of Pathology and Host Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Keiko Yamakawa
- Oncology Pathology, Department of Pathology and Host Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kosuke Saoo
- Oncology Pathology, Department of Pathology and Host Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Masanao Yokohira
- Oncology Pathology, Department of Pathology and Host Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Katsumi Imaida
- Oncology Pathology, Department of Pathology and Host Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Naoto Kuroda
- Diagnostic Pathology, Konan Medical Center, Hyogo, Japan
| | - Yoko Matsuda
- Oncology Pathology, Department of Pathology and Host Defense, Faculty of Medicine, Kagawa University, Kagawa, Japan
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57
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Uraguchi K, Kozakura K, Fukuda M, Marunaka H, Doi A, Ohta T, Iwata J, Kariya S. An autopsy case of Trousseau's syndrome with tumor thrombosis in unknown primary squamous cell carcinoma of the head and neck. Int Cancer Conf J 2020; 10:15-19. [PMID: 33489695 DOI: 10.1007/s13691-020-00440-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 08/09/2020] [Indexed: 12/11/2022] Open
Abstract
Trousseau's syndrome (TS) and tumor thrombosis (TT) are known as cancer-associated thrombosis with poor prognosis. TS is extremely rare in patients with squamous cell carcinoma. In this study, we report an unknown primary squamous cell carcinoma of the head and neck (SCCHN) patient with TS and TT in pulmonary artery definitely diagnosed by autopsy. A 73-year-old man had a past surgical history for unknown primary SCCHN and lung metastases. Three years after the initial surgery, the patient had multiple cerebral infarction, deep venous thrombosis in the legs and mediastinum metastases. Our diagnosis was TS and treatment with chemotherapy and unfractionated molecular heparin started. It could help control the hypercoagulative state and cancer progression, but finally, he died from progressive disease (mediastinum metastases and pulmonary embolism) five years after the initial surgery. An autopsy revealed multiple metastases and thrombosis in the pulmonary artery with squamous cell carcinoma microscopically. Although there is no established treatment for managing TS, intensive therapy such as a combination of chemotherapy and anticoagulant therapy can be effective in improving hypercoagulation therapy. In addition, an autopsy should be considered for patients with thrombosis to distinguish between TS and TT.
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Affiliation(s)
- Kensuke Uraguchi
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan.,Department of Otorhinolaryngology, Kochi Health Sciences Center, Kochi, Japan
| | - Kenichi Kozakura
- Department of Otorhinolaryngology, Kochi Health Sciences Center, Kochi, Japan
| | - Maki Fukuda
- Department of Neurosurgery, Kochi Health Sciences Center, Kochi, Japan
| | - Hidenori Marunaka
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
| | - Akira Doi
- Department of Otorhinolaryngology, Kochi Health Sciences Center, Kochi, Japan
| | - Tsuyoshi Ohta
- Department of Neurosurgery, Kochi Health Sciences Center, Kochi, Japan
| | - Jun Iwata
- Department of Pathology, Kochi Health Sciences Center, Kochi, Japan
| | - Shin Kariya
- Department of Otolaryngology-Head and Neck Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558 Japan
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58
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Yoshikawa S, Hara T, Suzuki M, Fujioka M, Taniguchi Y, Hirata KI. Imatinib Dramatically Improved Pulmonary Hypertension Caused by Pulmonary Tumor Thrombotic Microangiopathy (PTTM) Associated with Metastatic Breast Cancer. Int Heart J 2020; 61:624-628. [PMID: 32350209 DOI: 10.1536/ihj.19-556] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare malignancy-related respiratory complication, showing rapid progression of respiratory dysfunction and pulmonary hypertension (PH). Accumulating evidence suggests that imatinib, a platelet-derived growth factor (PDGF) receptor-tyrosine kinase inhibitor, might be effective and improve severe PH in patients with PTTM associated with gastric cancer. However, its efficacy in PTTM with breast cancer is generally believed as very limited. We experienced a rare case of PTTM associated with metastatic breast cancer, a rare case who were treated with imatinib, exhibiting significant improvement of respiratory dysfunction and PH.
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Affiliation(s)
- Sachiko Yoshikawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Tetsuya Hara
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Masataka Suzuki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Miyu Fujioka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Yu Taniguchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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59
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Onoda H, Imamura T, Inao K, Kinugawa K. How to Diagnose and Treat Pulmonary Tumor Thrombotic Microangiopathy. Int Heart J 2020; 61:409-412. [PMID: 32173712 DOI: 10.1536/ihj.19-549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We report here a 70-year-old female patient with a history of breast cancer who presented with dyspnea that had lasted for 2 weeks following a long-distance trip by bus. She was at first suspected of having a pulmonary embolism given the typical presentation, elevated D-dimer level, and enlargement of the right-side heart. However, her systemic condition deteriorated despite the initiation of anti-coagulation therapy. Given the absence of a major thrombus in the pulmonary major arteries but multiple low perfusion lesions in the periphery of the lungs, refractoriness to conventional therapy, an increase in tumor markers, and anaplastic cells demonstrated by aspiration cytology from the pulmonary artery, we diagnosed her as pulmonary tumor thrombotic microangiopathy (PTTM). She died on day 23 due to respiratory failure despite administration of inotropes and prostaglandin I2. The patient had an obvious history of malignancy, but we should emphasize that PTTM can develop even in patients with early-stage or completely cured malignancies. Although an early and definite diagnosis of PTTM is currently challenging, an optimal diagnostic and therapeutic strategy is warranted.
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Affiliation(s)
- Hiroshi Onoda
- The Second Department of Internal Medicine, University of Toyama.,Division of Cardiology, Niigata Prefectural Central Hospital
| | - Teruhiko Imamura
- The Second Department of Internal Medicine, University of Toyama
| | - Kyoko Inao
- The Second Department of Internal Medicine, University of Toyama
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60
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Kamada H, Ota H, Terui Y, Sugimura K, Fukui S, Shimokawa H, Takase K. Three cases of pulmonary tumor thrombotic microangiopathy (PTTM): Challenge in antemortem diagnosis using lung perfusion blood volume images by dual-energy computed tomography. Eur J Radiol Open 2020; 7:100212. [PMID: 33102634 PMCID: PMC7569404 DOI: 10.1016/j.ejro.2020.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/14/2019] [Accepted: 01/05/2020] [Indexed: 12/22/2022] Open
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a specific type of tumor embolism in the small and medium pulmonary arteries, leading to rapid progressive pulmonary hypertension. Antemortem diagnosis of PTTM is extremely difficult. We encountered three patients who were histopathologically or clinically diagnosed with PTTM. In all cases, lung perfused blood volume (PBV) images on dual-energy computed tomography (CT) demonstrated multiple subpleural wedge-shaped defects with no evidence of pulmonary embolism on CT pulmonary angiography. The lung PBV images demonstrated small pulmonary arterial obstruction reflecting the pathology of PTTM. Therefore, lung PBV imaging would be useful for antemortem diagnosis of PTTM.
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Affiliation(s)
- Hiroki Kamada
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Hideki Ota
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
| | - Yosuke Terui
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Koichiro Sugimura
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shigefumi Fukui
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Takase
- Department of Diagnostic Radiology, Tohoku University Hospital, Sendai, Japan
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61
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Burciaga Calderoni C, Moretta DT, Merrill-Henry J, Giri PC. Pulmonary tumor thrombotic microangiopathy presenting as recurrent syncope. SAGE Open Med Case Rep 2020; 8:2050313X20969044. [PMID: 35154770 PMCID: PMC8826092 DOI: 10.1177/2050313x20969044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 10/04/2020] [Indexed: 11/17/2022] Open
Abstract
Pulmonary tumor thrombotic microangiopathy is a rare condition in which embolization of tumor cells to the pulmonary arterioles causes fibrocellular intimal thickening and activation of the coagulation cascade resulting in pulmonary hypertension and right heart failure. Herein, we highlight a young 35-year-old male with no known past medical history who presented with recurrent syncope and dyspnea, and was found to have severe right heart failure and pulmonary hypertension. He developed sudden clinical deterioration and died after a cardiac arrest. Autopsy revealed poorly differentiated gastric adenocarcinoma and pulmonary tumor thrombotic microangiopathy. New onset severe pulmonary hypertension and right heart failure without any other obvious etiology should encourage the reader to evaluate for pulmonary tumor thrombotic microangiopathy and undergo a diligent search for underlying malignancy. This case highlights recurrent syncope as a rare presentation of this rapidly fatal disease.
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Affiliation(s)
| | - Dafne T Moretta
- Department of Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
| | - Jeanette Merrill-Henry
- Department of Respiratory Care Services, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Paresh C Giri
- Department of Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA
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62
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Yu O, Rikiya T, Yasuyuki M, Mikio S. Docetaxel chemotherapy temporarily improved pulmonary tumor thrombotic microangiopathy induced by prostate cancer secreting carcinoembryonic antigen and carbohydrate antigen 19-9: A case report. Urol Case Rep 2019; 29:101098. [PMID: 31908960 PMCID: PMC6938851 DOI: 10.1016/j.eucr.2019.101098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 12/10/2019] [Indexed: 11/25/2022] Open
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare, rapidly progressive, and often fatal complication of cancer, particularly prostate cancer. A 67-year-old man with advanced prostate cancer developed dyspnea. Chest computed tomography revealed ground-glass opacities across bilateral lung fields, and echocardiography showed right heart failure. As PTTM was suspected, docetaxel chemotherapy was administered immediately. His respiratory condition and right heart failure improved; however, 2-months later his respiratory symptoms were exacerbated, causing death. Autopsy showed fibrocellular intimal proliferation of the small pulmonary arteries, which confirmed PTTM induced by prostate cancer. Although PTTM is fatal, early diagnosis and treatment would improve the prognosis.
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Affiliation(s)
- Osaki Yu
- Department of Urology, Himeji Medical Center, 68 Honmachi, Himeji-shi, Hyogo-ken, 670-8520, Japan
| | - Taoka Rikiya
- Department of Urology, Kagawa University Hospital, 1750-1 Mikicho Ikenobe, Kida-gun, Kagawa-ken, 761-0793, Japan
| | - Miyauchi Yasuyuki
- Department of Urology, Kagawa University Hospital, 1750-1 Mikicho Ikenobe, Kida-gun, Kagawa-ken, 761-0793, Japan
| | - Sugimoto Mikio
- Department of Urology, Kagawa University Hospital, 1750-1 Mikicho Ikenobe, Kida-gun, Kagawa-ken, 761-0793, Japan
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63
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Febres-Aldana CA, Wymer DT, Burke WF, Vincentelli C. Recurrent metastatic breast cancer manifesting as pulmonary tumor thrombotic microangiopathy with interstitial pulmonary fibrosis and infarcts: A clinicopathological correlation. Respir Med Case Rep 2019; 28:100958. [PMID: 31720206 PMCID: PMC6838523 DOI: 10.1016/j.rmcr.2019.100958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 10/22/2019] [Indexed: 11/29/2022] Open
Abstract
Pulmonary Tumor Thrombotic Microangiopathy (PTTM) is a fatal complication of malignancy characterized by embolization of tumor cells to the pulmonary vasculature leading to a vascular reaction resulting in stenosis and pulmonary hypertension. Because the clinical manifestations of PTTM overlap with those of other entities, premortem diagnosis is challenging. We describe an unusual case of PTTM as the only clinical manifestation of recurrent metastatic breast cancer. A 50 year-old woman presented with hypoxemia and echocardiographic findings consistent with pulmonary hypertension and cor pulmonale. Correlation of premortem pulmonary imaging with autopsy histopathologic findings revealed that ill-defined ground-glass opacities identified on CT angiogram corresponded to areas of cellular interstitial fibrosis and widespread intrapulmonary tumor emboli involving predominantly small-sized arteries with associated florid intimal fibrosis. The radiologic nodularities and scattered peripheral wedge-shaped consolidations corresponded to evolving pulmonary infarcts on histopathology. Although retrospectively, the imaging findings were concordant with a spectrum of increasing severity of tumor embolization and vascular remodeling, the diagnosis of PTTM was not made premortem. PTTM is a rare entity that must be considered in cancer patients with unexplained hypoxemia, pulmonary hypertension and lung opacities on imaging.
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Affiliation(s)
- Christopher A Febres-Aldana
- Arkadi M. Rywlin Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, 33140, USA
| | - David T Wymer
- Department of Radiology, Mount Sinai Medical Center, Miami Beach, FL, 33140, USA
| | - William F Burke
- Department of Radiology, Mount Sinai Medical Center, Miami Beach, FL, 33140, USA
| | - Cristina Vincentelli
- Arkadi M. Rywlin Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, 33140, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, 33199, FL, USA
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64
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Byoun JT, Cho JY. Fatal progressive right heart failure in a pancreatic cancer patient. Yeungnam Univ J Med 2019; 37:122-127. [PMID: 31661753 PMCID: PMC7142028 DOI: 10.12701/yujm.2019.00332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 09/10/2019] [Indexed: 12/26/2022] Open
Abstract
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare but fatal complication of cancer and causes pulmonary hypertension and acute/subacute right heart failure. PTTM is most commonly associated with gastric cancer and more rarely associated with pancreatic cancer. We report a case of progressive right heart failure associated with clinically diagnosed pancreatic cancer, suggesting PTTM.
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Affiliation(s)
- Jeong Tae Byoun
- Department of Cardiology, Wonkwang University Hospital, Iksan, Korea
| | - Jae Young Cho
- Department of Cardiology, Wonkwang University Hospital, Iksan, Korea
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